Search results

This paper provides an overview of the evidence base for alcohol‐related brain injury (ARBI) and describes how this has been used to develop a pilot programme for the treatment of ARBI. Key components include: detoxification, assessment, social behaviour network therapy, cognitive rehabilitation and systematic instruction. The programme is being delivered and evaluated in the north of England by Swanswell, a national drug and alcohol treatment charity.

Alcohol‐related brain damage (ARBD) is an increasing challenge for service providers working with older people and adults. It has a complex aetiology and does not progress in the same way as other causes of dementia. The devastating effects of ARBD undermine a person's ability to lead an independent life, yet it is thought that with the right interventions, a degree of recovery can be seen in 75% of sufferers. People with ARBD do not neatly fit into an existing category of care; they ‘fall through the net’ at multiple points in the care pathway. Using a patient synopsis drawn from clinical practice the author illustrates the impact of an advanced practice role in relation to the nursing care of patients with ARBD, as well as making suggestions for the provision of education and support for mainstream services.

Alcohol-related brain injury (ARBI) is part of a group of conditions that do not fit easily into existing systems of care. People living with ARBI require flexible health and social services to ensure they receive person-centred, therapeutic care and treatment. Effective service provision promotes recovery for people who continue to experience significant levels of morbidity and mortality due to symptoms that are potentially reversible or at least amendable to appropriate care and treatment options. There exist significant gaps in the provision of this care for these vulnerable populations.

A literature review was undertaken of various scholarly databases (e.g. CINAHL, MEDLINE and Web of Science), as well as government and non-government publications and reference materials. Publications were included for analysis if they reported participant cohorts who had a diagnosis of ARBI or were carers or service staff involved with individuals who lived with ARBI.

In total, 31 publications on the needs of people living with ARBI were reviewed. Of the 67 sources identified a total of 31 were accessed and retrieved. Four main themes were identified: under-recognition and lack of a timely diagnosis, inadequate service provision and limited care pathways, stigma, and homelessness. Sources came from Australian, British, North American and Canadian literature.

Significant gaps were found in both the literature and in current clinical practices when it comes to the identification, care and treatment of people with ARBI. Globally, ARBI policy, treatments and service provision is often not available and when it does exist, it lacks consistency. Variations in models of care are significant given the fact that the predicted increase in per capita alcohol consumption will see a disproportionate increase in ARBI in future generations. This review was generated by the lack of contemporaneous evidence and may be considered a starting point for future research looking into the needs of individuals living with ARBI.

This international literature review contributes to a broader understanding of the issues and problems faced by people with ARBI. Of the 67 resources identified through a rigorous search method only 31 were relevant to people who live with ARBI in relation to care and support services. This indicates a lack of research in this area but that which needs to be undertaken. The review also highlighted service disconnection and the need for specific, tailored treatment approaches for people with ARBI. It was also found that the identification of ARBI in clinical practice has been protracted by the lack of systemised and standardised screening tools to use in the assessment of those who display signs and symptoms of these conditions.

The purpose of this paper is to argue that alcohol-related brain damage (ARBD) is a neglected problem. ARBD is a term that has begun to be used over the past decade to describe prolonged cognitive impairment caused by alcohol use, including Wernicke's encephalopathy and Korsakoff syndrome, alcohol dementia and alcohol-related brain injury.

The paper provides an overview of ARBD describing the research around its prevalence and prognosis. There is a consensus in the literature that there is little research and a lack of awareness of this condition. The author uses case studies from his own experience working with people with ARBD to describe the difficulties in accessing appropriate assessment and care for this group, and suggests that they are often excluded in a way that is familiar from the experience of the person with “dual diagnosis”.

Recommendations are made including raising awareness, improving screening for cognitive impairment and developing specialist services.

ARBD appears to have been neglected in the “dual diagnosis” world and this paper attempts to address this, and so should be of interest to a wide range of professionals working with substance use, mental health, homelessness and social work.

As rates of dangerous drinking increase, services must improve their understanding of the needs of people with alcohol‐related brain damage such as Korsakoff syndrome (KS). This study looked at indications of change in key functioning areas for four people with KS living in a new supported living environment. The research highlighted the individualised and complex needs of people with KS and suggests that three specific factors may influence changes in functioning.

This paper seeks to explore some of the issues around older people and alcohol.

The paper highlights good practice through case studies and identifies some practical ways to prevent and reduce the risk of alcohol abuse by older people.

More brief intervention for older drinkers, more specialist projects for older drinkers, and training and support for staff in all services dealing with older people who misuse alcohol is urgently needed. Additionally, specialist training for dementia services to enable them to work effectively with alcohol‐related brain injury and drinkers in drug and alcohol services who are ageing are also needed. Finally, we need more research on substance misuse in older people, primarily in order to generate practical responses.

The epidemic of excessive drinking described by the media fails to include people over 65, even though there is plenty of evidence to show that they are experiencing many of the same social and economic pressures as young people.

The assessment of cognitive impairment in community services for older people remains under-explored. The paper aims to discuss this issue.

Cognitive impairment was examined in 25 people aged 65 and over with alcohol use disorders, on the caseload of community mental health services over a six-month period. All subjects assessed using Addenbrooke’s Cognitive Assessment (ACE-III).

In total, 76 per cent of the group scored below the cut-off point for likely dementia but only 45 per cent of people scored below the cut-off point for tests of language, compared with 68-84 per cent people in other domains.

This finding has implications for the detection of alcohol-related brain cognitive impairment in clinical settings.

Standardised cognitive testing is common within mental health services for older people, but may also have utility within addiction services.

The early detection of alcohol-related cognitive impairment can improve social outcomes in both drinking behaviour and the social consequences of alcohol-related dementia.

This may be the first published study of cognitive impairment in patients under a mental team for older people with alcohol use disorders and offers some unique findings within this sampling frame.

There is growing statistical and research evidence to suggest that the prevalence of alcohol misuse is increasing among older adults in the UK. This has been an under‐recognised problem, but is now a source of increasing concern for health and social care providers. Older adults with mental health problems have increased vulnerability to problematic alcohol use, and this is likely to have a significant impact on older people's mental health services (OPMHS).

This paper discusses some of the problems facing OPMHS in relation to increasing alcohol misuse among services users.

There is also evidence that alcohol misuse in older adults is often poorly identified and untreated within health and social care services including OPMHS. Use of an alcohol‐screening tool as part of a health care assessment is an effective way to improve detection. This paper also reviews the use of alcohol screening tools in the detection of alcohol related illness among older adults with mental health problems and proposes a care pathway for the management of alcohol misuse in OPMHS.

Current evidence indicates that the prevalence of alcohol misuse among older adults is increasing and is likely to rise further due to the reasons discussed in this paper.